Babies feel more pain than doctors realise

Doctors are underestimating the pain babies feel because some show no outward signs of discomfort, a study has found.

By Rebecca Smith, Medical Editor

4:41PM BST 23 Jun 2008

Newborn babies show pain and discomfort through body movements, changes in blood pressure and facial expressions although they may or may not cry.

But new research has shown that the traditional signs medical professionals look for may only detect the most severe pain.

A team at University College London warned that infants may appear to be pain free but actually are still experiencing discomfort.

Babies display pain by grasping, flexing their arms and legs, arching their back and splaying their fingers as well as a range of facial expressions.

Researchers at UCL studied brain activity in 12 babies, some of whom were born prematurely, when they were having a painful medical procedure.

They found changes in facial expression, including a grimace, squeezing eyes shut and furrowing the brow, were best indicators the baby was in pain.

But also some of the babies showed brain changes associated with pain but no physical sign raising concerns doctors could be underestimating discomfort in these children.

The team believes the work can help doctors and eventually parents to use physical clues to establish if and how much pain babies are experiencing.

Dr Rebeccah Slater, lead author from UCL Neuroscience, Physiology and Pharmacology, said: "Although our study was small, it does raise concerns about the tools normally used by doctors to establish whether a baby is feeling pain.

"Infants may appear to be pain free, but may, according to brain activity measurements, still be experiencing pain. It would be exciting to explore whether measures of brain activity could complement current methods for measuring pain in infants."

Dr Slater said relying on a baby's cry may not be the best way to establish pain, especially in premature or very young babies in hospital.

She added: "Babies do cry when they are in pain, but they also cry when they are cold, hungry, tired and stressed. So, just because a baby is crying it might not be in pain - it is not a specific response to pain.

"Also, some babies do not cry at all when they are in pain."

There are also physical reflexes to a pain such as withdrawing a hand or foot which does not necessarily mean the baby is experiencing pain, it is just an automatic reflex action.

The research is published in the Public Library of Science: Medicine journal.